Under the plans, which will be delivered in partnership with community services, practices will also be expected to help develop personalised care plans for all care home residents and coordinate phamacy teams to undertake structured medication reviews and provide advice to care homes on medication issues.
In a letter to practices on 1 May, NHS England said that primary care networks (PCNs) 'should be the default' scale for providing the service, and that networks should identify a named clinical lead for each care home.
NHS England said it wanted all practices to take part, but that it would be ‘less burdensome’ for practices, and 'better for care homes', if the service was delivered at a PCN level. 'The intention is that from 1 October, the model will be adapted to support the service specification already set out in the network contract directed enhanced service,' it added.
Weekly check ins
The letter said that NHS England would be collecting weekly data from CCGs starting this week to determine the level of coverage across the country, adding that it could decide to bring in 'regulatory provision' to ensure all care homes were covered.
Last week NHS England stressed that the new requirements for practices were 'outside' of the network contract DES. In a webinar on 30 April NHS England primary care medical director Dr Nikki Kanani said: 'We know that the DES doesn't start until October. We're not trying to force it through or put it in, in a way that isn't right or honourable, [but give] clinical guidance that if, in your patch, you are not able to currently support your care homes, we might be able to find a way through getting more support to you, and more resources.'
NHS England's letter said that the weekly 'check ins' should be undertaken remotely where appropriate and could be delivered by a multidisciplinary team 'drawing on general practice and community services staff and expertise'. 'Appropriate and consistent medical oversight and input from a GP and/or geriatrician' is also expected, but it will be up to practices or PCNs to determine the frequency of this.
As part of the check ins clinicians will be expected to review patients identified as a clinical priority, including those with suspected COVID-19. They should also introduce remote monitoring of patients with COVID-19 'using pulse oximeters and other equipment'.
Funding for practices
However the letter provided little clarity on funding available for practices that incurred extra costs in order to deliver on the requirements. During the webinar on 30 April Dr Kanani said that NHS England would set out 'how we'll make sure that the funding follows what you do'.
'We're not at all saying do stuff without funding, we recognise that that is not sensible,' she added.
However, the letter simply says that any additional costs incurred by practices 'may be eligible for reimbursement'.
'A reimbursement mechanism for general practice will be established to help practices meet the additional costs of COVID-19 related activity which cannot be met from existing practice resources. Reimbursement will be managed through CCGs, on the basis of national guidance,' the letter added.
NHS England said that in parts of the country where local arrangements 'go beyond the service model set out... these should not be disrupted.'
BMA GP committee chair Dr Richard Vautrey welcomed the fact that NHS England was not aiming to force through any aspect of the network contract DES, however he warned that practices needed to be properly renumerated for any additional work.
Dr Vautrey said: 'CCGs and local authorities must now work to support this, by enabling care homes to use virtual consultations to a greater extent. This should facilitate multidisciplinary working, not just with practices, but also community nursing teams and secondary care specialists.
'It goes without saying that where practices have additional costs as a result of their COVID-19 response efforts, this will need funding. We also need those CCGs that don't have local schemes in place to resource additional support for care homes to rapidly commission those.'